Journal article
Management of Aortic Stenosis in Patients With End-Stage Renal Disease on Hemodialysis
Circulation. Cardiovascular interventions, Vol.13(8), pp.e009252-e009252
08/01/2020
DOI: 10.1161/CIRCINTERVENTIONS.120.009252
PMCID: PMC7422925
PMID: 32772570
Abstract
Background: Patients with end-stage renal disease on hemodialysis (ESRD-HD) and aortic stenosis have poor prognosis. The role of transcatheter aortic valve replacement (TAVR) in this high-risk population is debated. Methods: We compared the outcomes among ESRD-HD Medicare beneficiaries who were managed with TAVR, surgical AVR (SAVR), or conservative management for aortic stenosis between 2015 and 2017, using overlap propensity score weighting analysis to control for differences in treatment assignment. The primary outcome was all-cause mortality and was compared between treatment groups as well as to age-sex matched mortality for ESRD-HD in the US population. Secondary outcomes included trend of heart failure hospitalizations. Results: A total of 8107 ESRD-HD patients with aortic stenosis were included, 4130 (50%) underwent TAVR, 2565 (31.6%) underwent SAVR, and 1412 (17.4%) were managed conservatively. TAVR patients had more comorbidities and higher frailty compared with the other 2 groups. Thirty-day mortality was lower with TAVR compared with SAVR (4.6% versus 12.8%,P<0.01). After a median follow-up of 465 days (interquartile range, 261-759), on overlap propensity score weighting analysis, there was no difference in mortality between TAVR and SAVR (adjusted hazard ratio, 1.02 [95% CI, 0.91-1.15],P=0.7), and mortality was lower with TAVR compared with conservative management (adjusted hazard ratio, 0.53 [95% CI, 0.47-0.60],P<0.001). Standardized mortality ratios with TAVR, SAVR, and conservative management compared with age-sex matched ESRD-HD US population were 1.24, 1.27, and 1.83, respectively. The rate of heart failure admissions declined after TAVR (incidence rate ratio, 0.55 [95% CI, 0.48-0.62],P<0.001) and SAVR (incidence rate ratio, 0.76 [95% CI, 0.65-0.88],P<0.001). Conclusions: In ESRD-HD patients with aortic stenosis, mortality was lower in the short-term with TAVR compared with SAVR but comparable in the mid-term. AVR is associated with an improvement in survival and reduction in heart failure hospitalizations compared with conservative management.
Details
- Title: Subtitle
- Management of Aortic Stenosis in Patients With End-Stage Renal Disease on Hemodialysis
- Creators
- Amgad Mentias - Roy J. and Lucille A. Carver College of MedicineMilind Y. Desai - Cleveland ClinicMarwan Saad - Brown UniversityPhillip A. Horwitz - Roy J. and Lucille A. Carver College of MedicineJames D. Rossen - Roy J. and Lucille A. Carver College of MedicineSidakpal Panaich - Roy J. and Lucille A. Carver College of MedicineHani Jneid - Baylor College of MedicineSamir Kapadia - Cleveland ClinicMary Vaughan-Sarrazin - Iowa City VA Medical Center
- Resource Type
- Journal article
- Publication Details
- Circulation. Cardiovascular interventions, Vol.13(8), pp.e009252-e009252
- DOI
- 10.1161/CIRCINTERVENTIONS.120.009252
- PMID
- 32772570
- PMCID
- PMC7422925
- NLM abbreviation
- Circ Cardiovasc Interv
- ISSN
- 1941-7640
- eISSN
- 1941-7632
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 9
- Grant note
- T32 HL007121 / NIH Kirschstein National Research Service Award; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Health Services Research and Development Service (HSRAMP;D) of the Department of Veterans Affairs R01AG055663-01 / National Institute on Aging (NIA); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA)
- Language
- English
- Date published
- 08/01/2020
- Academic Unit
- Neurology; Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Neurosurgery; Internal Medicine
- Record Identifier
- 9984302210002771
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